﻿<!DOCTYPE html>
<html>
<head>
    <meta charset="utf-8">
    <title>提交领取信息</title>
    <meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=no">

    <link rel="stylesheet" href="../components/lib/bootstrap.min.css" />
    <link rel="stylesheet" href="../components/lib/fontawesome/css/font-awesome.min.css" />
    <link rel="stylesheet" href="../components/lib/toastr.min.css" />
    <link rel="stylesheet" href="../components/lib/style.css" />
</head>

<body class="app-body">

    <div id="loading" class="loading"><img src="../components/images/loading.gif"></div>

    <div id="main" style="display:none">
        <script class="controller" type="text/html">
            <div class="header">
                <p class="title" id="alertTitle">提交领取信息</p>
            </div>
            <div class="app-pd-15">
                <div class="alert alert-success" id="alertMessage">
                    恭喜，您已获得优惠券领取资格！请填写以下信息，确认后即可获取领取凭证。
                </div>

                <form id="myForm" role="form">
                    <%if (conponActInfo.isFormRealName){%>
                    <div class="form-group">
                        <label for="realName" class="control-label">
                            <%=conponActInfo.formRealNameTitle%>：
                        </label>
                        <input type="text" id="realName" class="form-control" placeholder="请填写您的<%=conponActInfo.formRealNameTitle%>" data-error="请填写您的<%=conponActInfo.formRealNameTitle%>" required>
                        <div class="help-block with-errors"></div>
                    </div>
                    <%}%>
                    <%if (conponActInfo.isFormMobile){%>
                    <div class="form-group">
                        <label for="mobile" class="control-label">
                            <%=conponActInfo.formMobileTitle%>：
                        </label>
                        <input type="tel" pattern="^1[3|4|5|7|8][0-9]\d{4,8}$" id="mobile" class="form-control" placeholder="请填写您的<%=conponActInfo.formMobileTitle%>" data-error="请填写您的<%=conponActInfo.formMobileTitle%>" required>
                        <div class="help-block with-errors"></div>
                    </div>
                    <%}%>
                    <%if (conponActInfo.isFormEmail){%>
                    <div class="form-group">
                        <label for="email" class="control-label">
                            <%=conponActInfo.formEmailTitle%>：
                        </label>
                        <input type="email" class="form-control" data-error="请填写正确的<%=conponActInfo.formEmailTitle%>" id="email" placeholder="请填写您的<%=conponActInfo.formEmailTitle%>" required>
                        <div class="help-block with-errors"></div>
                    </div>
                    <%}%>
                    <%if (conponActInfo.isFormAddress){%>
                    <div class="form-group">
                        <label for="address" class="control-label">
                            <%=conponActInfo.formAddressTitle%>：
                        </label>
                        <input type="text" id="address" class="form-control" placeholder="请填写您的<%=conponActInfo.formAddressTitle%>" required>
                    </div>
                    <%}%>
                    <div id="divBtn" class="app-center"><button type="button" onclick="controller.submitApplication(1);" class="btn btn-block btn-info btn-lg">确 认</button></div>
                </form>

            </div>
            <%if (!isPoweredBy){%>
            <div class="footer">
                <p>技术支持：阁下 <a href="http://www.gexia.com" target="_blank">GEXIA.COM</a></p>
            </div>
            <%}else if(poweredBy){%>
            <div class="footer">
                <p><%==poweredBy%></p>
            </div>
            <%}%>
        </script>
    </div>
</body>
</html>

<script src="../components/lib/jquery-1.11.0.min.js"></script>
<script src="../components/lib/bootstrap.min.js"></script>
<script src="../components/lib/bootstrap.validator.min.js"></script>
<script src="../components/lib/json2.js"></script>
<script src="../components/lib/template.js"></script>
<script src="../components/lib/toastr.min.js"></script>
<script src="../components/lib/notifyService.js"></script>
<script src="../components/lib/utilService.js"></script>

<script src="scripts/service.js"></script>
<script src="scripts/applicationController.js"></script>
